Clinical and Radiological Results after Fracture-Dislocations of the Ankle: A Medium- to Long-Term Followup Study

Luna, Vincenzo De; Caterini, Alessandro; Casci, Chiara; Marsiolo, Martina; Efremov, Kristian; Maio, Fernando De; Farsetti, Pasquale

doi:10.3390/jfmk7020030

Cited by 4 publications

(2 citation statements)

References 20 publications

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“…Mid-term and long-term functional outcome have also been studied in relatively small cohorts [47,48].…”

Section: Discussionmentioning

confidence: 99%

Timing of fracture fixation in ankle fracture-dislocations

Penning,

Tausendfreund,

Naryapragi

et al. 2024

Preprint

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Purpose Ankle fracture-dislocations are the result of high energy trauma with concomitant soft tissue damage and may require delayed internal fixation. Our aim was to compare the use of acute ORIF with delayed ORIF, using external fixation or cast splint in ankle fracture-dislocations. We identify which factors affect the rates of re-operation and SSI. Methods In this retrospective cohort study, we included patients with open and closed ankle fracture-dislocations treated with ORIF from two large peripheral hospitals and one academic centre in the Netherlands. We used binary logistic regression for univariate and multivariate analyses to calculate which factors influence outcome. Results We included 447 patients with an ankle fracture-dislocation. In the multivariate analysis, the difference between surgery <48 hours compared to bridging with cast or external fixation had no significant influence on unscheduled re-operation or SSI. Higher Body Mass Index (BMI) and open fractures had a significant positive correlation with re-operation and diabetes mellitus (DM) and open fractures correlated with SSI. In patients with open fractures, there was also no significant difference in outcome between acute or delayed internal fixation. Conclusion We suggest that it is safe to perform primary ORIF on all dislocated ankle fractures if the soft tissue injury allows surgery within 48 hours. When significant swelling is present, temporary immobilization is a safe option to allow for surgery. Patients with well-reduced fractures and with no soft tissue injury could be treated safely with a cast until delayed ORIF is possible.

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“…Mid-term and long-term functional outcome have also been studied in relatively small cohorts [47,48].…”

Section: Discussionmentioning

confidence: 99%

Timing of fracture fixation in ankle fracture-dislocations

Penning,

Tausendfreund,

Naryapragi

et al. 2024

Preprint

View full text Add to dashboard Cite

show abstract

“…Fractures of the ankle are one of the most prevalent types of injuries that may involve the lower limb, affecting mostly young men and elderly women [ 1 , 2 ]. These fractures may happen with or without dislocation, considering only around ten percent are caused by trauma [ 3 ]. A fracture-dislocation of the ankle is a rare injury produced by severe trauma that includes the bone and soft tissues surrounding the ankle or in any other combination [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

Avoiding the Removal of Syndesmotic Screws after Distal Tibiofibular Diastasis Repair: A Benefit or a Drawback?

Hosin

Vermeşan

Prejbeanu

et al. 2022

JCM

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There is still no general agreement about the most effective form of syndesmosis fixation with syndesmotic screws for patients affected by ankle fractures that are accompanied by syndesmotic injuries. In the same manner, no consensus has been reached yet on whether or not the tibiofibular syndesmotic screw is more beneficial if removed or not, as well as the exact timing of removal if this proves superiority. The purpose of this research was to verify whether or not removing syndesmotic screws reduces the risk of developing a diastasis and compare outcomes in patients whose syndesmotic screw was or was not removed at all. A retrospective observational study was carried out to cover a period of five years and a computed sample size of almost 300 cases. Patients were included in the current study if their history was positive for ankle fracture with distal tibiofibular diastasis repair with syndesmotic screws. Loss of reduction was more frequent after screw removal (8.5% vs. 2.1%), although the quality of reduction was generally excellent in both groups. The mean AOFAS score was significantly better in patients who had their tibiofibular screw removed (92.6 vs. 88.4), but the tibiofibular clear space and incisura fibularis depth widened more following the second intervention (3.8 mm vs. 3.6 mm, and, respectively, 4.3 vs. 4.1). Lastly, the same patients with tibiofibular screw removal had a significantly higher cost of total interventions and more days of medical leave (21 vs. 15 days on average). It seems that a strong conclusion in favor of removing or not removing syndesmotic screws after distal tibiofibular diastasis repair cannot be given. However, several radiographic findings lean toward the benefit of those patients whose tibiofibular screws were not removed, although mobility was notably better after the screw was removed. Furthermore, treatment expenses are greatly lowered if a subsequent operation for screw removal is avoided, as well as if individuals who have a single surgery take a shorter medical leave.

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Current Trends in the Surgical Treatment of Fibular Fractures: A National Database Study of Intramedullary vs. Plate Fixation Practice Patterns, Complications, and Cost

Zhang,

Litvak,

Lin

et al. 2024

Advances in Orthopedics

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Existing primary evidence comparing fibular intramedullary fixation (IMF) with traditional plate fixation (PF) for the treatment of distal fibular fractures remains limited by modest sample sizes. Using a large national database, this study aims to compare use rates, fracture patterns, patient characteristics, time to surgery, complication rates, and cost between fibular IMF and PF within the United States. Adults treated with fibular IMF or PF between October 2015 and October 2021 were identified within the PearlDiver Database. The ratio of IMF‐treated to PF‐treated patients was tracked temporally to compare use rates. Fracture patterns were determined using fracture diagnoses within one‐month preceding surgery. Further comparisons of IMF‐ and PF‐treated groups only included patients with at least 12 months of follow‐up, and patients with upper tibia or tibia shaft fractures were excluded. An analysis of cohorts matched at a 1 : 4 (IMF: PF) ratio to control for risk factors was performed to compare time to surgery, complication rates (infection, nonunion, malunion, revision, hardware removal, pulmonary embolism, and deep vein thrombosis), and cost. 39329 patients (2294 IMF and 37035 PF) were identified. IMF use trended upwards relative to PF use over time. Tibia and fibula shaft fractures were the most common injuries in IMF patients versus bimalleolar and trimalleolar fractures in PF patients. A higher proportion of IMF patients had open fractures. IMF patients were younger, with higher mean ECI, fewer female patients, and higher rates of CKD. Percutaneous approaches were more common among IMF patients. There were no significant differences in time to surgery or complication rates. IMF was less costly. The popularity of IMF trended upwards across the study period. IMF was used more commonly in injuries involving higher energy trauma and soft tissue disruption. Overall, IMF patients were younger with more comorbidities. When used in similar populations, IMF appears to be a cost‐effective alternative to PF.

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Clinical and Radiological Results after Fracture-Dislocations of the Ankle: A Medium- to Long-Term Followup Study

Cited by 4 publications

References 20 publications

Timing of fracture fixation in ankle fracture-dislocations

Timing of fracture fixation in ankle fracture-dislocations

Avoiding the Removal of Syndesmotic Screws after Distal Tibiofibular Diastasis Repair: A Benefit or a Drawback?

Current Trends in the Surgical Treatment of Fibular Fractures: A National Database Study of Intramedullary vs. Plate Fixation Practice Patterns, Complications, and Cost

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